This inspection was a focussed, unannounced inspection of acute wards for adults of working age provided by Derbyshire Healthcare Foundation NHS Trust. The inspection was focussed to specific areas of the 5 key questions and specifically on Ward 35 at the Radbourne unit.
At our last inspection we rated the acute wards for adults of working age and psychiatric intensive care units as requires improvement.
We carried out this unannounced focused inspection because we had concerns about the quality of services following a routine visit by a Mental Health Act reviewer and to look at those parts of the service that did not meet legal requirements following our last inspection in 2019.
As this was a focussed inspection for Ward 35 at the Radbourne unit, we have not rated the service and the previous rating of requires improvement remains in place. Ward 35 is a 20 bedded female acute and admission ward.
We previously inspected the trust’s acute wards for adults of working age and psychiatric intensive care units (PICUs) at the Radbourne Unit in November 2019. The November 2019 inspection was a routine inspection. The main areas of improvement identified during the inspection in November 2019 were around blanket restrictions, staff training and governance processes.
The concerns raised by the Mental Health Act reviewer were around patients not knowing their rights under the Act, incidents not being reported and followed up appropriately, patients not being able to store personal possessions securely, patient risks not being assessed and care planning not being in place for patients.
The purpose of this inspection was to look into these concerns and to see if the trust had met the requirements of the previous inspection on Ward 35.
Due to the seriousness of the concerns following our site visit, in September 2023 we used our powers under Section 31 of the Health and Social Care Act, to request assurances from the trust to ensure the ward was safe, patients received the right care and treatment and appropriate measures were in place to monitor these changes. The trust responded immediately and put appropriate measures in place with a detailed action plan.
We raised a number of immediate concerns with the trust and they took immediate actions to make improvements on the ward including immediate improvement with the ward environment, restrictive practices, informing patients of their rights and improving and updating care plans and risk assessments.
- The trust still had dormitories but had a dormitory eradication programme was in place for all the trust’s sites and it is planned this work will be completed for Ward 35 in March 2026.
- Managers did not ensure patients and staff received appropriate support after being involved in or witnessing serious incidents.
- Staff did not always have a thorough handover that included incidents and support required by patients after incidents.
- The clinic room was not cleaned regularly, and medication audits were not robust and did not assess, monitor and improve medication management. Staff were not aware of the illicit drug policy and the correct recording processes around this.
- The ward ligature risk assessment was not robust and did not give clear guidance on mitigating measures in place for all ligature anchor points.
- Staff sickness levels were high and increasing on the ward and appropriate systems and support was not in place to reduce this.
- The ward had a high usage of bank and agency workers that were not trained in the trusts restrictive intervention programme and therefore were unable to support the ward if restrictive interventions were required.
- Staff were not supported through regular managerial supervisions.
- The service did not operate effective systems and processes to ensure that managers monitor assessed and improved quality of services.
- Staff mandatory training compliance rates had improved since our last inspection.
How we carried out the inspection
During our inspection on 19 and 20 September 2023, we visited Ward 35, an acute ward for adults of working age at The Radbourne Unit.
During the inspection we:
- observed how staff cared for patients.
- spoke with 5 patients who were using the services.
- spoke with 10 staff including a ward manager, nurses, nursing assistants, clinical leads and an advanced clinical practitioner.
- looked at the quality of the ward environment.
- reviewed 4 patient records.
- reviewed 9 incident records.
- reviewed a range of policies, procedures and other documents relating to the running of the services.
You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.
What people who use the service say
During the inspection we spoke with 5 patients and 2 family members. All 5 patients and both family members we spoke to told us staff were generally kind, but they were always rushed, and the ward felt understaffed. In addition, they also told us they were not aware they could have access to their care plans and had not been involved in their developing these.
One patient told us the occupational therapists were really good and there were activities available every day.
Two informal patients told us they both had only been informed of their rights 2 days ago. One patient detained under the Mental Health Act told us staff had tried to explain their rights to them, but this was not done clearly so they did not really understand their rights.
Three out of the 5 patients we spoke to told us they had belongings that had been stolen and 1 felt as nothing was labelled, they ended up using other people’s items.